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DOI: 10.1055/s-2004-816846
Effect of donor gender on graft survival following orthotopic heart transplantation
Objectives: Clinical outcome for women compared with men following HTX is assumed to be worse but is controversial.
Material and Methods: Based on the general observation that men who receive a female heart show a worse clinical outcome (48±0,6% vs. 46,2±1% for 10-year survival), we studied the impact of donor gender on graft survival in 1263 patients with HTX for whom 32,6% of donors were female.
Results: Of 229 (18,1%) women transplanted, 146 (63,7%) received a female heart. Women suffered more often from dilated cardiomyopathy (70,1% vs. 62,7%), NYHA Class IV (37,2% vs. 31,2%) but less often from diabetes (8,7% vs. 16,2%). Women showed a better 10-year survival rate (58% vs. 46%). Clinical outcome in women was better when HTX was performed for dilated cardiomyopathy compared with ischemic heart disease and when women were not bridged to HTX by an assist device. Gender specific aspects of mortality showed that women died more often due to infection (30,1% vs. 25,8%) and hemorrhage (4,3% vs. 2,9%). However, cause of death could less often be ascribed to rejection (7,5% vs. 10,7%), malignancy (7,5% vs. 8%) and graft failure (26,9% vs. 31,4%).
Conclusions: Women who received female hearts performed best. In women who received male hearts, clinical outcome was better compared with that of men who received male hearts. A partial explanation may be that lower co-morbidity in female recipients may play an essential role since a possible advantage of receiving a female heart is lost in men.